Dr. Javier Del Pozo Roselló,

From the age of 40, between 14% and 35% of women experience urinary incontinence. This frequency peaks between the ages of 50 and 60 years. From the age of 60, urge incontinence and mixed types increase, while stress incontinence decreases.

It is very important because the treatment is different in each case, ranging from pysiotherapy to bio-feedback, electro-stimulation, medical treatment or surgery.

Urinogynecology is a sub-speciality of obstetrics and gynecology for the diagnosis and treatment of pelvic floor disorders. It covers frequent cases such as urinary incontinence and prolapse of the pelvic organs, but is in fact more complicated; it also includes fecal incontinence, bladder evacuation disorders, difficulty in defecation, sexual disfunction and chronic pain. It must therefore be treated conjointly and from a comprehensive and integral point of view.

The pelvic floor is all the muscles, ligaments, connective tissue and nerves that support and control the uterus, vagina, bladder, urethra and rectum.

• Urinary incontinence: involuntary loss of urine.
• Loss of control of stool and discharge of gases.
• Genital prolapse: a condition in which the pelvic organs descend from their normal anatomical position towards the vagina, with the feeling of a "lump" at the level of the external genitalia.
• Pelvic pain, soreness or pain in the bladder or urethra.
• Disorder or discomfort in sexual relations.

They are exercises to improve elasticity and muscular strength, to strengthen closure of the urethra and prevent urine loss. The aim is to tone up the muscles of the pelvis, maintain muscular contraction and increase the number of repetitions, and they are known as Kegel exercises. They can be combined with the use of vaginal cones.

There are two approaches:

• Transvaginal surgery: by means of Tension-free Vaginal Tape, TOT, cystorraphy... It is performed in cases of SUI or mixed type incontinence in which no other disorder of the pelvic floor is involved. It is a quick and simple operation performed with general anaesthetic and leads to rapid recovery with satisfactory results. This type of operation is favourably received by patients, even those of more mature years.
• Laparoscopic surgery: when urinary incontinence is associated with uterine prolapse, the most frequently employed technique is the Burch operation (retropubic colposuspension), since with laparoscopy other procedures for reestablishing the normal support for genital structures can also be used at the same time, such as colposacropexis with tension-free tape.

A more direct view of the deeper areas of the pelvis is achieved, with easier access to anatomical spaces which are difficult to reach with other types of surgery. This provides better identification and analysis of the support defects, so that sutures are far more precise and effective than with traditional surgery. Blood loss during the operation is much less; post-operative pain is also reduced, with less need for medication; scarring is almost negligible; time spent in hospital is less; recovery is quicker, and the patient can return to work much earlier.